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Kidney care.

Kidney Care

The phone call to my office was from one of my mother's doctors at Iowa Methodist Hospital in Des Moines. He told me that my mother had just died. I called to tell my sister, my brother, and my mother's husband of less than a year. Then, thinking I might reach another brother who had been with her, I called her hospital-room number. I was put on hold, and you can imagine my joy when the silence was broken by voices in the background saying, "She's breathing on her own! She's breathing!'

Could it possibly be that there would be another chance to say good-bye . . . another chance to tell her how much we loved her?

The doctor called back and confirmed that mother was breathing on her own and had been taken to intensive care.

My husband and I flew to Iowa, where another miracle of modern medicine was dramatically demonstrated to us. My mother had been confused and disoriented from uremic poisoning (urea in the blood). She had been nearly comatose, and she couldn't recognize anyone. But after just one dialysis treatment, she was saying, "I got my mind back.' I sang "Silent Night' to her, and she began singing along with me. Tears welled in my brother's eyes when he said, "I love you, mom,' and she replied, "I love you too.'

My sister, who had held my mother's cold, limp hands the night before, couldn't believe that, after a single dialysis treatment, she was returning loving smiles. Because my mother was also a victim of cancer, persons not medically trained might quite naturally believe that the cancer had spread to the brain and caused irreversible damage.

Another of my mother's doctors had made her second chance possible. He is a nephrologist, trained at Harvard Medical School, who had been recommended when I called Harvard to consult an authority on nutrition for patients with kidney failure.

"You happen to have in Des Moines one of the finest men on this subject,' I was told. "He is Dr. Craig Shadur. I'll give you his address and phone number.' And it was Dr. Shadur who gave us hope that my mother's brain function could come back after he set up the dialysis for her. My mother's brain was not functioning only because her kidneys weren't able to remove the urea and the nitrogen wastes from her blood. This poisoning is measured by the blood-urea-nitrogen (BUN) laboratory blood test. Normal BUN runs about 15 to 20; hers was over 200. After the first dialysis treatment, it dropped to 93, and she knew us again!

Dialysis, or the artificial kidney, was invented by a Dutch physician, Dr. Willem Kolff. The procedure removes the blood from the body and runs it through filters so that the impurities are removed, just as the kidneys would have done had they been working. When a patient suffers from renal shutdown (kidney failure), the urea in the blood continues to accumulate until a coma ensues. Potassium is not removed by the kidneys either, and it too builds up in the blood. The high potassium interferes with the heart's rhythm and eventually causes it to stop beating.

At first there weren't enough artificial kidneys (dialysis machines) to keep all kidney-failure patients alive. Committees were set up at that time whereby a minister, a physician, or other community members would be burdened with the responsibility of deciding who should live and who should not. Mercifully, today dialysis equipment is available to all without the need of a committee to make such difficult decisions. A major lifesaving function of the dialysis equipment is to keep a person alive until a donor kidney can be found for transplanting. Nearly 15,000 people in the United States are living with kidney machines and waiting for kidneys to become available. Dr. Kolff's latest contribution to society is a dialysis machine that fits like a backpack and enables a person to go about his work or play while being dialyzed.

Dr. Barry M. Brenner, one of the physicians at Harvard who trained Dr. Shadur in nutrition for kidney patients, is forging into a new area of preventive medicine. He believes we could prolong the useful life of kidneys, and postpone the need for dialysis by feeding people less protein. He points out that there may be a fundamental mismatch between the evolutionary design characteristics of the human kidney and the functional burden imposed by modern high-protein eating habits. Sustained rather than intermittent excesses of protein in the diet cause increases in renal blood flow. This increase requires the "reserve' capacity of the outer portions of the kidney to be used more or less continuously, causing an unrelenting "intrarenal hypertension' and predisposing even healthy people to a deterioraion of renal function. The biologic price of our highprotein diet is acceptable in the absence of diabetes, acquired renal disease, or surgical loss of a kidney. But more pronounced elevations in blood pressure in these conditions may lead to more rapid loss of renal function. Dr. Brenner points out that an obvious first step for these patients might be a reduction of protein intake, implemented early in the course of intrinsic kidney disease.

As the body burns protein, ammonia is left as a waste. This is converted into urea. Urea is the principle waste product the kidneys have to eliminate. The amount of this waste is determined by the amount of protein in one's diet. Urea is also produced during starvation, when the lack of sufficient carbohydrates forces the body to burn some of its protein to maintain life. (This is like chopping up the boxcars to keep the engine going!)

Excessive protein in the diet burdens the kidneys with excessive urea. This problem is often compounded in older individuals who do not drink sufficient water. More water does not make more work for the kidneys. In fact, the opposite is true--more water makes the kidneys work easier.

Dr. Giuseppe Maschio, chief of nephrology at the University of Verona, Italy, has conducted the largest study to date on the effects of diet in kidney failure. His new data were compiled by following 349 patients on a restricted-protein diet for 36 months. Sixty-one percent achieved a stabilization of kidney function; that is, the progression of their disease had halted. He noted that the results were not influenced by the age, sex, or general health of the subject.

One of Dr. Maschio's colleagues in Naples found that it took patients on a protein-restricted diet 91 months for their disease to progress to kidney failure and to dialysis treatments. However, for patients whose protein intake was not restricted, dialysis became necessary after only 16 months.

Dr. Maschio believes early intervention is critical in moderating the effects of the disease. Unfortunately, he fears most physicians in the United States are reluctant to start their patients on the diet because of America's love affair with protein. "You eat much more protein than you need in this country,' he says. "I have no difficulty cutting a gentleman living in Verona from 70 grams of protein a day down to 50 grams,' he noted. "However, I'm sure I would have much more trouble controlling the diet of a man in Los Angeles who is eating 150 grams of protein a day.'

"With nearly two-thirds of your patients stabilized on a protein-restricted diet, will their condition eventually deteriorate?' Dr. Maschio was asked. "We don't know,' he said. "We have a number of patients who have not suffered further kidney deterioration in ten years, and that's very unusual. In the meantime, I can tell you that we're saving the government a lot of money by postponing dialysis.'

In the United States, dialysis costs the federal government about $25,000 per year per patient. There are approximately 80,000 people on dialysis, many of whom could come off dialysis if only more transplant kidneys were available. The Society wants to encourage our readers to think about donating organs whenever they lose a family member.

The Colitis-Arthritis Connection

For some time, arthritis has been recognized as one of the complications of ulcerative colitis. Reports from our survey strongly indicate that many people treating their colitis with the research diet are experiencing improvement of their arthritis, which suggests that the arthritis many people suffer from is due to mild colitis or irritablebowel syndrome. The correct treatment of their arthritis, therefore, might not be drugs, but diet.

Our colitis research questionnaire was first used to survey members of a celiac-sprue (irritable-bowel disease due to wheat intolerance) convention in Des Moines, Iowa. The questionnaires were tabulated, and some surprising associations noted. One-fifth of the celiacsprue victims had had kidney stones, and one-half had also suffered from arthritis.

The high frequency of kidney stones among the celiacsprue victims prompted this question: Might not kidney-stone formers show a high frequency of irritable-bowel disease?

The same questionnaire was sent out to the Kidney Stone Formers Club membership. As the results of this second survey came in, it was apparent that at least half the kidney-stone formers had irritable-bowel disease.

The high association of arthritis and irritable-bowel disease has prompted us to ask a second corollary question: Might not the joint disease of many of those suffering from arthritis be due to irritable-bowel disease? (Our preliminary evidence suggests that a high percentage of victims of osteoarthritis might have the disease as a consequence of often mild irritable-bowel disease.)

We would like to invite those suffering from arthritis to write for our research questionnaire and diet. We hope to learn and to report to you how many arthritic patients will be relieved of their arthritis by treating their irritable-bowel condition with this research diet. Send to Colitis Club, P.O. Box 567, Indianapolis, IN 46206.

Odor from Marijuana

Please tell "Anonymous,' in Hulbert, Oklahoma, in the December issue, that her son's clothing and room odor sound exactly like the smell left behind after smoking marijuana. Many, many years ago I briefly tried it, and I know the smell, which she describes as a chicken coop. Even before that, I had a boyfriend who had this odd smell and later I found out he smoked it too.

Another clue is the son's weight gain, laziness, and bad disposition--all symptoms of marijuana smoking. It creates a hunger for sweets, or just about anything, and the smoker becomes ravenous when high.

Hope this helps the mother to help her son to stop smoking it if he is, as it can be very dangerous and destructive to the body, emotions, and spirit--take it from one who wishes she had never seen it--I was "turned on' to it by my "knight-in-shining-armor' first husband, and nobody ever suspected (especially my family).

D.W. Atlanta, Georgia

Gas Problems

Dear Dr. SerVaas:

Please do a column on a problem I understand a majority of people suffer from: intestinal gas.

I have suffered with this embarrassing problem for years and have only received temporary relief after consulting several doctors. Nothing works for long. It is an unbearable, embarrassing condition.

I have avoided apples, lima beans, sweet potatoes-- and still I suffer from it.

Please write an article on it, and perhaps you can help me and others.

Jane Patterson Baltimore, Maryland

Clove Cigarettes

Recent reports indicate that clove cigarettes, a new fad among teen-agers, are far more dangerous than tobacco cigarettes. According to Dr. Fredrick G. Schechter, an associate professor of surgery at the University of California, smoking clove cigarettes may lead to shortness of breath, coughing up blood, pulmonary edema (swelling of the lungs), exacerbation of colds or existing pulmonary illness, and death.

A $25 million lawsuit has been filed in California against the manufacturers, importers, and distributors of clove cigarettes, by the parents of a 17-year-old boy who died of bronchopneumonia several days after smoking clove cigarettes. An asthmatic woman died after passively inhaling smoke from clove cigarettes.

The Centers for Disease Control in Atlanta is receiving several phone calls per day regarding the adverse effects of clove-cigarette smoking. Health scientist Gailya Walter of the CDC reports that "seven cases of hospitalization and/or deaths' have been associated with the smoking of clove cigarettes.

The cigarettes contain 65 to 70 percent high-tar (30 to 40mg), high-nicotine, low-grade tobacco and one-third ground cloves. The severe irritation caused by these cigarettes is masked by eugenol, a powerful topical anesthetic contained in the cloves. (The eugenol itself is a harsh irritant.)

A special hot line for clove-cigarette complications has been established by Dr. Schechter. The telephone number is (213) 945-LUNG.

Prevent Drunk Driving

This idea came from the executive director of the Children's Better Health Institute: Bartenders might have their guests check their keys as they arrive for the evening. Later the bartender would have the privilege of giving the merrymaker a breath test to see if he was still in the legal limit to drive. If not, he could insist on calling a cab or having the intoxicated visitor driven to his home. If there were such a law, perhaps drunk-driving deaths would decrease.

Innocent AIDS Victims

The National Hemophilia Foundation is now recommending that hemophiliacs refrain from having children because 85 to 90 percent of them carry the AIDS antibody. This unfortunate situation could have been prevented if we had followed the practice of handling blood as it is done in Australia. There, bloodprotein fractions are taken from individual blood donations, instead of from mixed pools of hundreds of thousands of transfusions, as is done here. The incidence of AIDS in Australian hemophiliacs is quite rare.

Hemophiliacs should lobby Congress to force companies to make antihemophiliac factor from individual units of donated blood, rather than the customary pooling of donors.

A recent study has shown that, among homosexuals, either cigarette or marijuana smoking increases the risk of getting AIDS by 3 1/2 times.

Chicken Pox

When our daughter Joan thought B.J., their three-year-old son, had chicken pox last week, she wanted to know why lysine couldn't work since chicken pox is caused by a herpes virus.

We called a lysine authority, Dr. Richard Griffith, at Indiana University, and he suggested 50 mg of lysine per kilo of body weight. B.J. weighs 40 pounds or about 20 kilos (1 kilo = 2.2 pounds) so this totaled about 1,000 milligrams of lysine. Dr. Griffith suggested breaking up two 500 mg tablets into applesauce or mashed potatoes. Joan used cheese balls and it worked very well. Dr. Griffith reports that in the past, when a family member has had chicken pox, others in the family have, after being given lysine, had milder cases of chicken pox or none at all.

We appreciated Dr. Griffith's assurance that lysine is safe for children. He recommended a similar dose for B.J.'s 18-month-old brother, who weighs 35 pounds and showed no signs of chicken pox.

A vaccine for chicken pox is nearly ready for mass production.

Dear Dr. SerVaas:

I have had the same foot burning condition and could never have a cover on my feet in bed. Now I sit with the balls of my feet on an "ice pack' of frozen gelatin. Ice cubes will not work; the "pack' is colder.

Charmian Greer Szaltenis Pittsburgh, Pennsylvania

Photo: Nephrologist Craig Shadur fine tunes the nutrition of patients with kidney failure and those undergoing kidney transplants. For our family, he provided another chance to say good-bye to our mother when he brought her back from the shadow of death. Harvard-trained nephrologists such as Dr. Shadur are studying the prevention or postponement of kidney failure with low-protein diets.

Photo: Dialysis teams like this throughout the world give life to some 80,000 patients with kidney failure. Many are kept alive with dialysis until a donor kidney becomes available for transplant. Our dialysis team consisted of a technician, Kathy Lee (left), and Karen Shelley, a registered nurse, with a portable dialysis unit for our mother, Trudy Van Ekeren.

Photo: The heart of the mechanical kidney is the boat-shaped plastic tank. Inside this-tank, a long, membranous tube is folded. The patient's blood is pumped through the tube and returned to his body. The wastes from the blood diffuse through the membrane into the surrounding saltwater solution that fills the tank.
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Title Annotation:effects of diet on kidney patients
Author:SerVaas, Cory
Publication:Saturday Evening Post
Date:Mar 1, 1986
Previous Article:Virgin Islands: bargain sails.
Next Article:When Medicare no longer cares; how to take the pain out of the "medigap" that lies between federal assistance and actual costs of health care.

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